Epworth Antimicrobial Stewardship (AMS) participated in the 2017 National Antimicrobial Prescribing Survey (NAPS). This point-prevalence survey, administered by the National Centre for Antimicrobial Stewardship, assesses the prevalence and appropriateness of antimicrobial prescribing in Australian hospitals.
The charts of 456 overnight patients, across 30 wards at all acute divisions (excluding Geelong), were reviewed to identify antimicrobial prescriptions. All prescriptions valid at 08:00, or surgical antibiotic prophylaxis (SAP) administered within the preceding 24 hours were recorded.
The drug, dose, route, duration, and indication for therapy, plus relevant microbiology or biochemistry results were recorded. Prescriptions were assessed for compliance with Therapeutic Guidelines, or Epworth SAP Guidelines; and also appropriateness, recognising limitations of guidelines.
45% patients were prescribed ≥1 antimicrobial. 296 prescriptions were assessed.
67.2% prescriptions were assessed as appropriate, 29.4% as inappropriate, 3.4% could not be assessed. Appropriateness was poorer than the national benchmark and the 2016 Epworth result (both 74.6%). Prescribing appropriateness at Epworth has improved compared to pre-implementation of the AMS program (52% in 2012).
SAP represented 36.5% of all prescriptions, but 73.6% of inappropriate prescriptions.
40.7% of SAP prescriptions were assessed as appropriate, down from 46.5% in 2016.
The most frequent reasons to deem SAP as inappropriate were: incorrect duration (48.1%), and incorrect dose or frequency (28.7%). SAP continued for >24 hours post-operatively for 50.9% of prescriptions.
A SAP-specific NAPS conducted at Epworth in 2017, also capturing procedures for which no antimicrobials were prescribed, and day cases, found higher rates of prescribing appropriateness peri-operatively (60%), and post-operatively (74.7%).